Category: Diabetes

The group of disorders called diabetes mellitus is comprised of several similar conditions. They are characterized by either the body’s resistance to insulin action or deficient levels of insulin (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). There are four general types of diabetes: “type 1 diabetes, type 2 diabetes, gestational diabetes mellitus (GDM),” and diabetes developed from other causes (ADA, 2015, p. 98). These four categories have individual signs, characteristics, and recommendations. Type 2 diabetes evolves in people due to the combination of genetic and environmental factors as well as the person’s life choices (ADA, 2014).

For this particular condition, health care providers develop a plan that includes pharmacological and non-pharmacological treatments. One of the proposed drug treatments is Metformin – the primary choice for initial therapy (ADA, 2015). The non-pharmacological approach often includes dietary restrictions that focus on controlling glucose and lipid levels. Diabetes development changes a person’s life because it requires one to make significant lifestyle changes and creates a dependence on medications.

Types of Diabetes

As is mentioned above, one can distinguish four main categories of diabetes according to their causes and onset. The first one is type 1 diabetes (juvenile diabetes), in which it is thought that the body destroys its pancreatic beta cells (Arcangelo et al., 2017). Then, the absence of these cells leads to insulin deficiency. This is a chronic condition, and it can occur at any age, although the majority of cases develop early. A variety of factors can influence type 1 diabetes, but all causes are not thoroughly researched or confirmed (ADA, 2014).

Another category is type 2 diabetes. In this case, the pancreas starts producing less insulin or the impact of insulin becomes less effective on the muscle and adipose cells of the body (Arcangelo et al., 2017). Thus, as a result of the insulin’s lowered impact, glucose levels in the blood rise significantly. Type 2 diabetes develops in people with time, the majority of patients being more than 30 years old (ADA, 2015). However, the rate of type 2 diabetes continues to increase in children, which may signify changes in people’s health and lifestyle (ADA, 2014; Peterson, Silverstein, Kaufman, & Warren-Boulton, 2007). Risk factors for this type include a family history of type 2 diabetes, obesity, and dieting choices.

GDM occurs in pregnant women who become intolerant of glucose. It should be noted that patients can be misdiagnosed with GDM, although they have type 2 diabetes which progressed during pregnancy and became more apparent and active than before (ADA, 2014). As a contrast, some GDM cases resolve after delivery and do not require further pharmacological support. Finally, other types of diabetes include type 1 diabetes in children, drug-induced diabetes, and other uncommon developments that lead to insulin dysfunction (ADA, 2014). They require additional diagnostics to find the cause and possible solutions.

Drug Treatments for Type 2 Diabetes

First of all, it is vital to note that healthcare providers can help patients to suppress or regulate the development of type 2 diabetes. To achieve this, they can create a therapy plan and include both pharmacological and non-pharmacological measures to control glucose levels. After type 2 diabetes is detected, the drug therapy can start with Metformin, a medication that lowers glucose production and increases the sensitivity of the body to insulin (ADA, 2015). While it does not reduce blood glucose significantly, it works in a way that supports the patient’s condition. This is a drug that is usually prescribed as a first-line treatment option because it has a low risk of side effects and a high rate of effectiveness (ADA< 2015). However, if it is not working well enough, other medications can be added to the therapy.

Dietary Considerations

Drug therapy may not be the only treatment option for patients with type 2 diabetes. People often have to make other changes to their lifestyle, focusing especially on their diet. As this disorder is strongly related to the production of glucose and its levels in one’s blood, it is reasonable to suggest for patients to control their diet (Balk et al., 2015). Non-pharmacological recommendations include weight loss for overweight people and a diet that has less processed and more whole foods, including vegetables, fruit, whole grains, lean meat, healthy sources of protein, and low-fat dairy (Esposito et al., 2015). Research studies indicate that plant-based diets that also restrict the consumption of processed and artificial foods improve patients’ health (Esposito et al., 2015). However, dietary considerations should be developed according to patients’ characteristics and financial abilities.

The Impact of Diabetes

Type 2 diabetes can alter people’s life drastically, changing their diet, lifestyle, activities, and health. For example, untreated diabetes can lead to many other issues such as cardiovascular problems, hypertension, kidney damage, vision impairment, hearing problems, and others (ADA, 2015). Short-term changes are also visible as type 2 diabetes symptoms include fatigue, increased thirst and hunger, acanthosis nigricans, and low resistance to infections (ADA, 2014). If a person treats diabetes, he or she has to control his/her diet and physical activity. Moreover, drug therapy also leads to the person becoming dependent on medication.

Conclusion

Diabetes mellitus is a severe problem that can affect people of all ages and backgrounds. The onset of type 2 diabetes depends on a variety of factors such as a person’s family history and lifestyle choices. It is a rising problem in both adults and children, especially because of its connection to unhealthy foods and obesity. Type 2 diabetes is usually treated with Metformin, a drug that increases the body’s sensitivity to insulin. However, the individual should also assume control of his/her diet and physical activity to slow down the development of the disorder and avoid complications.

References

American Diabetes Association [ADA]. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Supplement 1), S81-S90.

American Diabetes Association [ADA]. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 33(2), 97-111.

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Balk, E. M., Earley, A., Raman, G., Avendano, E. A., Pittas, A. G., & Remington, P. L. (2015). Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: A systematic review for the Community Preventive Services Task Force. Annals of Internal Medicine, 163(6), 437-451.

Esposito, K., Maiorino, M. I., Bellastella, G., Chiodini, P., Panagiotakos, D., & Giugliano, D. (2015). A journey into a Mediterranean diet and type 2 diabetes: A systematic review with meta-analyses. BMJ Open, 5(e008222), 1-10.

Peterson, K., Silverstein, J., Kaufman, F., & Warren-Boulton, E. (2007). Management of type 2 diabetes in youth: An update. American Family Physician, 76(5), 658–664.

Abstract

The paper is devoted to the investigation of the central features of the cost-effectiveness analysis on the background of the suggested case revolving around diabetes among the population of the USA. The better understanding of the topic is achieved by comparing this type of analysis with the cost-benefit and cost-utility approaches to outline the main differences and situations when these tools can be applied.

Moreover, different perspectives on the cost analysis are introduced to attain the better understanding levels and guarantee that various cases where it can be utilized are discussed. Finally, categories of costs that should be included in CEA are analyzed with the primary aim to perform the in-depth analysis of all aspects of the discussed topic and familiarize readers with the critical elements that should be touched upon while applying the tool to various cases. In such a way, the paper contributes to the field of cost-effectiveness analysis by extending knowledge devoted to it.

Cost-Effectiveness Analysis

The cost-effectiveness analysis (CEA) is an important tool that is used to determine opportunities for further actions or outline advantages or disadvantages associated with a particular decision. For this reason, it is critical to attain higher understanding levels and be able to apply the tool to various cases to investigate them correctly.

Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analyses

The cost-benefit analysis presupposes that a specialist sums all possible benefits associated with a particular solution and then investigates costs related to this decision. A cost-effectiveness analysis is similar to this one; however, it is applied when it is impossible to place value on the outcome (Muennig, 2016). The cost-utility analysis presupposes that an investigator should determine whether an action or solution should be performed or applied (Edlin, McCabe, Hulme, Hall, & Wright, 2015). All these types of investigation can be used in the healthcare sector to determine the effectiveness of a certain approach.

Relationship Between Cost and Effectiveness

There is a direct correlation between the cost and effectiveness as the best possible performance can be achieved due to the minimization of input and maximization of output. In other words, more effectiveness should not cost more money (Muennig, 2016). On the contrary, the detailed cost-effectiveness analysis can help to select the most potent solution that can help to avoid extra spending and save money while achieving outstanding results, which is critical for the healthcare sector.

Perspective of the Analysis

Doing the CEA for situations that presuppose the involvement of more than one actor, it is critical to consider the perspective from which the analysis is performed. The fact is that effectiveness is determined regarding the impact of a certain decision on a particular party, which means that another one can experience losses (Muennig, 2016). That is why there are societal and single player perspectives that should be considered. Regarding the case, costs demanded to perform screening are ignored as individuals should pay for them.

Kinds of Costs

CEA usually considers two types of costs which are fixed and variable. It is demanded to make an accurate forecast and determine the benefits of a particular decision (Roberts et al., 2017). Speaking about the case, the discussed treatment and screening spending can be considered a fixed cost as they remain constant regardless of the changes in output and can impact the final results.

Streams of Cost

Performing CEA analysis, it is critical to get streams of cost over time to monitor the current situation and remain informed about the possible alterations in input (Muennig, 2016). It will help to achieve higher efficiency levels and ensure that the utilization of the given analysis will contribute to the generation of benefits needed to achieve success.

References

1. Edlin, R., McCabe, C., Hulme, C., Hall, P., & Wright, J. (2015). Cost effectiveness modelling for health technology assessment: A practical course. New York, NY: Adis.
2. Muennig, P. (2016). Cost-effectiveness analysis in health: A practical approach (3rd ed.). New York, NY: Jossey-Bass.
3. Roberts, S., Barry, E., Craig, D., Airoldi, M., Bevan, G., & Trisha, G. (2017). Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes. BMJ Open, 7(11). Web.

Introduction

The situation discussed in this essay involves Ms. G., a waitress at a local diner. Ms. G. has been diagnosed with Type I diabetes mellitus, an illness that can have a significant overall impact on her health and ability to work. As such, concerns related to her ability to continue with her current employment have surfaced. No specific information regarding Ms. G.’s current symptoms has been made available, however. As such, the purpose of this essay is to identify and address the particular factors that would have to be considered in the course of an evaluation of Ms. G.’s work capabilities.

Physical Concerns

Diabetes is associated with a variety of issues, including physical difficulties, mental impairments, and more severe complications. According to “Diabetes” (n.d.), the more common symptoms related to physical health include fatigue, vision loss, difficulty standing or walking, dizziness, and seizures. The first four symptoms can be debilitating for a waiter, as the job involves writing down orders and continuously moving back and forth to deliver them.

Dizziness can also be an issue, as a waiter is expected to carry dishes regularly. Seizures can be a severe impairment to any variety of work, but they are not as common as the three symptoms above and therefore are less of a concern. Ultimately, in an active occupation such as that of a waiter, the physical manifestations of diabetes can be a significant obstacle to the completion of one’s duties.

Mental Issues

In addition to physical concerns, diabetes is sometimes associated with mental difficulties. According to “Diabetes” (n.d.), the dangers include confusion and memory loss. Both of these conditions can impair a waiter’s ability to work by interrupting his/her coordination in the busy situation generally expected in a diner. However, the relative simplicity of Ms. G.’s work, as well as the tendency of waiters to write orders down instead of memorizing them, can allow her to keep working despite the impairments. If the symptoms surface, they should still be taken into consideration, but if her coworkers are aware of her situation, they should be able to assist her in overcoming the onset of the difficulties without interrupting the operation of the diner significantly.

Other Concerns

Type I diabetes is associated with a need for regular insulin injections and monitoring. Potential complications include heart disease, kidney failure, and limb amputation, and treatments that imply healthy eating and physical activity (“Diabetes” (n.d.)). While the more severe manifestations of the illness can greatly impair Ms. G.’s ability to keep working, her job allows her to have easy access to positive practices.

The nature of a waiter’s work involves considerable amounts of physical activity, and the diner’s kitchen can be relied on to provide healthy meals while Ms. G. is working. Furthermore, as waiters get breaks, no difficulties related to insulin injections should arise. Overall, as long as Ms. G.’s physical abilities do not become significantly impaired, she should be able to keep working without too much difficulty.

Conclusion

Diabetes is a condition that is associated with a variety of symptoms, both physical and mental. One cannot know in advance which of them will surface, and so the influence of each on Ms. G.’s work should be considered. Generally, the physical symptoms can prove debilitating to the job, while the mental ones can be circumvented. However, as long as she can keep working, the diner provides her with an excellent environment to carry out the general health guidelines.

Reference

Diabetes. (n.d.). Web.

Introduction

Technology has found its way to all spheres of people’s life, including health care. Present-day health practitioners should be aware of the latest developments in order to come up with the best treatment solutions for their patients. Using research for analysis and synthesis of scholarly data is one of the most effective ways of finding out details about important healthcare issues. The ability to critique data found via search engines testifies about a nurse’s professional skills and the level of preparation. The purpose of this paper is to explore the use of various databases, knowledge, and wisdom to perform and interpret research.

Research Question

Diabetes is one of the most common diseases with high mortality rates. Healthcare practitioners and scientists are constantly working on finding methods of relieving the symptoms and providing patients with appropriate treatment. However, some of the available medicines are not entirely beneficial for patients, leading to dangerous side effects. To conduct a review of literature, it is necessary to identify a patient-related problem and then look for the most relevant information through web-based search engines.

The research question is “Are the side effects of metformin in diabetes treatment strong enough for practitioners to stop prescribing it to their patients?” Evidence-based practice (EBP) indicates that gastrointestinal infections decrease metformin tolerance in patients with diabetes (Huang et al., 2015a; Huang et al. 2015b). EBP also reports that about one-fifth of diabetic patients treated with metformin develop gastrointestinal side effects (Dujic et al., 2015). Thus, the literature review will be focused on searching evidence of metformin’s adverse effects on patients’ gastrointestinal system.

Databases and Search Words

When performing research, it is necessary to pay thorough attention to databases. For the current search, databases were limited by the subject “health sciences.” Such engines as MEDLINE, Science and Technology Collection, CINAHL, and Agricola were consulted. These are considered as some of the most reliable and extensive healthcare-oriented databases. To obtain the most relevant and trustworthy results, the hits matching the keyword were filtered twice: firstly, by the publication date (within the last five years), and secondly, by the source of publication (peer-reviewed scholarly journals). The following data were obtained for each database with the help of keywords and filters.

Medline

Keywords – metformin gastrointestinal side effects.

Results – 8,119,185 hits.

Inclusion – within the last five years.

Results – 1,754,700.

Inclusion – academic journals.

Results – 1,750,734.

Science and Technology Collection

Keywords – metformin gastrointestinal side effects.

Results – 1,365,658 hits.

Inclusion – within the last five years.

Results – 455,009.

Inclusion – academic journals.

Results – 444,418.

CINAHL

Keywords – metformin gastrointestinal side effects.

Results – 1,061,417 hits.

Inclusion – within the last five years.

Results – 455,009.

Inclusion – academic journals.

Results – 444,418.

Agricola

Keywords – metformin gastrointestinal side effects.

Results – 899,810 hits.

Inclusion – within the last five years.

Results – 239,723.

Inclusion – academic journals.

Results – 239,489.

Converting Information to Knowledge

Upon obtaining data through the search process, it will be possible to formalize the information with the help of knowledge. The initial step will be putting data points into perspective. Further, the analysis will be performed, taking into consideration the specific aspects of the research question and the most relevant sources out of the identified ones. For the present paper, the application of data will be performed with the aim of understanding the side effects of metformin on patients with diabetes.

Conclusion

Conducting research involves several important steps, including identifying keywords or phrases correctly and deciding on filters that will help a nurse to obtain the most reliable and relevant results. Having skills to operate various databases is crucial for nursing specialists. The use of technology is highly helpful in the process of research, which can help to enhance patients’ health and increase their safety during treatment procedures.

References

Dujic, T., Causevic, A., Bego, T., Malenica, M., Velija-Asimi, Z., Pearson, E. R., & Semiz, S. (2015). Organic cation transporter 1 variants and gastrointestinal side effects of metformin in patients with type 2 diabetes. Diabetic Medicine, 33(4), 511-514.

Huang, Y., Sun, J., Wang, X., Tao, X., Wang, H., & Tan, W. (2015a). Asymptomatic chronic gastritis decreases metmorfin tolerance in patients with type 2 diabetes. Journal of Clinical Pharmacy and Therapeutics, 40(4), 461-465.

Huang, Y., Sun, J., Wang, X., Tao, X., Wang, H., & Tan, W. (2015b). Helicobacter pylori infection decreases metformin tolerance in patients with type 2 diabetes mellitus. Diabetes Technology & Therapeutics, 17(2), 128-133.

Quantitative Study Design

Background of the Study

Diabetes is a chronic disease that affects the metabolism of glucose, which is the key physiological sugar. Type 2 diabetes occurs when the body develops resistance to the hormone insulin whose function is to lower blood glucose levels. Approximately 27 million people in the United States have type 2 diabetes, whereas 86 million have prediabetes [1]. Prediabetes is characterized by high blood glucose levels that have not reached the threshold required for the condition to be considered diabetes [1]. Recent statistics indicate that the global incidence of diabetes among adults above the age of 18 years has increased from 4.7% to 8.5% over the last 40 years [2]. Hemoglobin A1c (HbA1c) levels are useful indicators of blood glucose levels over three months. Healthy individuals without diabetes have HbA1c levels that range from 4% to 5.9% [3]. On the other hand, diabetic patients with poor blood glucose control have HbA1c levels exceeding 7%. Therefore, HbA1c levels are used to establish blood sugar control over time and are an indication of effective self-management among diabetic patients.

Group medical visit is a novel and time-effective strategy of providing care to patients with similar chronic disorders. Patients are requested to show up for these gatherings to receive care, teaching, and guidance within an empathetic group setting. Group medical visits are associated with enhanced patient self-management, which is the goal of health literacy. It is expected that group medical visits will motivate the patients to better self-care, which will translate into improved glycemic control and reduced HbA1c levels.

Significance

Diabetes is responsible for other health complications such as blindness, heart attacks, renal complications, stroke, and amputation of lower limbs. It is reported that lowering HbA1c levels by 1% reduces the likelihood of microvascular problems such as kidney failure, the diabetic eye, and nerve complications by 10% [4]. As a result, the American Diabetic Association recommends that HbA1c should be checked every six months in diabetic patients with stable blood sugar control [3]. The frequency of HbA1c testing should increase to every three months for patients who are attempting to establish unwavering blood sugar control. The management of diabetes involves adherence to medications, a healthy diet, and regular exercise. Despite this knowledge, the morbidities and mortalities associated with diabetes are on the increase due to noncompliance with medical advice. Studies indicate that patient education and healthcare staff recommendations lead to improved health outcomes [5]. Group medical visits have also been reported to improve patients’ reception and implementation of medical advice, which leads to improved outcomes [6]. There is a need to determine the impact of group medical visits on diabetes self-care and HbA1c levels. This knowledge will help to improve healthcare outcomes by enhancing the quality of life of diabetic patients. As a result, there will be significant savings on healthcare costs spent on treating the complications associated with diabetes.

Purpose of the Study

The purpose of the study is to determine the impact of group medical visits compared to individual medical visits on HbA1c levels among African Americans with type 2 diabetes mellitus.

The rationale for Selecting the Study Design

Quasi-experimental study design was chosen. Quasi-experimental research designs check for test-effect associations by establishing the consequences of an intervention on a target population. However, randomization is absent in this research design. A dependent variable, which is usually designated as X, is the anticipated outcome of implementing a specified intervention or treatment. An independent variable, conversely, is a self-determining factor that modifies a dependent variable. The independent variable may consist of different categories. Subjects are assigned to groups by the principal investigator or self-selection. The benefit of conducting a quasi-experimental study is that it is possible to conduct experiments in instances where randomization may not be feasible. In this study, the main intervention is group medical visits, which will be compared to individual visits (control). It will be necessary to assign subjects into groups based on their schedules so that they can attend group medical sessions without any inconveniences.

Research Question and Hypothesis

The research question for the study is “What is the impact of group medical visits compared to individual medical visits on HbA1c levels among African Americans with type 2 diabetes mellitus?” It is hypothesized that African Americans patients with type 2 diabetes mellitus patients who will undergo group medical visits will have lower HbA1c levels than those who will undergo individual medical visits. Therefore, the null hypothesis (H₀) for the study is: there is no significant difference in mean HbA1c levels in African American patients who undergo group medical visits compared to those who undergo individual medical visits. A one-tailed alternative hypothesis will be considered.

Study Design

A pre and posttest study design of the quasi-experimental research design will be used for the study. In this design, the dependent variable is assessed before and after implementing the intervention. Baseline HbA1c data will be collected at the beginning and end of the study. The two values will be compared to determine the impact of the intervention. One benefit of the pre and posttest study design is that it is easy to ascertain that the posttest values are consequences of the intervention.

Setting

The setting of the study will be an internal medicine clinic. The clinic provides a wide range of health services such as annual physical examinations, screening for hypertension, diabetes, and other chronic diseases. The populations served at the clinic include Whites, African Americans, Latinos, and a small group of Asians.

Sampling

The study sample will include African American patients with recently diagnosed type II diabetes mellitus. The subjects will be aged between 40 and 60 years. Patients suffering from other comorbidities such as renal disease, pancreatic disease, anemia, and type 1 diabetes will be excluded from the study. Pregnant women will also be excluded from the study.

Sample Size Determination

The statistical power of a study is the likelihood of identifying a predefined clinical significance. Ideal studies should have high power, which is the likelihood of detecting a significant difference between groups. The recommended power for most research studies is 80% [7]. For this study, a medium-sized effect is desired at α=0.05. Power analysis is used to determine the appropriate sample size as shown in the equation below.

In the above equation, N is the sample size, Z_α is the normal deviate at a specified level of significance (1.96 for 5% level of significance), and Z_1-β is the normal deviate at 1-β% power with β% of type II error. The value of Z_1-β is 0.84 at 80% power. On the other hand, r, which is the ratio of the sample size required for 2 groups is given by n1/n2. In this case, equal-sized groups are desired, therefore, r=1. σ is the pooled standard deviation, whereas d is the difference between the averages of 2 groups. Estimates of σ and d are obtained from previous studies or pilot investigations. A previous study that compared mean HbA1c levels between two groups found mean HbA1c levels of 65 and 68.3 mmol/mol and a common standard deviation of 10.05 [8]. Therefore, N= (1+1) (1.96+0.84)²10.05²/1* (68.3-65)², which is equal to approximately 145. Therefore, a total of 145 subjects with 72 subjects in each group will be appropriate for the study.

Intervention

The main intervention in the study will be group medical visits. The treatment group will be divided into 6 units comprising 12 patients each. Each group visit will last 90 minutes. During the group sessions, the physician will provide hands-on care, including routine blood pressure checks, blood sugar tests, HbA1c measurement, writing prescriptions for the refill of medications, and patient education. However, patients will be allowed to share their progress and challenges briefly, after which the physician will respond to any concerns. The control group will include subjects who will undergo normal individual medical visits lasting 15 minutes each. The procedures followed during the group medical visits will also be used for the individual visits.

Measurement

Lifestyle changes will lead to changes in glycemic control hence HbA1c levels. However, since lifestyle modifications cannot be measured explicitly, the outcome variables that will be measured are HbA1c levels and body mass indices. Blood samples will be drawn from all participants and tested for HbA1c levels using the immunoturbidimetric method in the clinic’s laboratory.

Procedures

Recruitment plan

Eligible patients will be invited to participate in the study through invitation emails that will be sent at least two months before the commencement of the proposed study.

Data collection method

Blood samples will be drawn from all participants and tested for HbA1c levels at the baseline (beginning of the study). The BMI values of the subjects will also be measured at this point. The second set of measurements will be taken 3 months after the commencement of the study. The third set of measurements will be taken 6 months later.

Intervention delivery

The intervention will be delivered to the subjects during their normal medical appointments with their physicians. Subjects in each group (for the group medical visit intervention) will be scheduled for their appointment on similar days to facilitate the convergence of the groups.

Data Analysis Plan

The pretest and posttest data will be compared to determine the effectiveness of the intervention. The mean HbA1c levels and BMIs of the subjects in the intervention and control groups will be compared using paired t-tests at 0.05 level of significance. Data analysis will be conducted using SPSS version 22 software.

Study Team

The study team will consist of a group of healthcare providers such as a nurse practitioner, two physicians, and registered nurses. The role of the physician will be to provide consultation services to the patients during the individual and group medical visits. The lab technologists will be responsible for performing the HbA1c tests.

Limitations of the Study

There is no guarantee that all subjects recruited at the beginning of the study will be present at the end of the research. Some patients may abandon the investigation and complicate the data analysis. Other subjects may become uncomfortable with the group medical visits or their schedules may change during the study hence forcing them to opt-out. This attrition will be factored into the data analysis at the end of the experiment. Confounding variables are uncontrolled factors that may affect the internal validity of an investigation. In this paper, confounding variables comprise all dynamics that affect HbA1c levels in diabetic patients. They include acute and chronic blood loss (losing blood lowers the survival of erythrocytes hence decreasing HbA1c levels), hemolytic anemias, blood urea (high levels increase HbA1c levels), and pregnancy (HbA1c levels reduce in the second trimester and rise in the third trimester). Other forms of anemia alter the quaternary structure of hemoglobin, which influences its glycation rates. Consequently, HbA1c levels are likely to be higher in anemic people than normal ones.

Internal validity indicates whether the outcomes observed in an investigation are as a result of the alteration of the independent variable and not because of other factors. The internal validity of the study will be ensured by taking care of the confounding variables in the inclusion and exclusion criteria. External validity, conversely, represents the generalizability of an experiment to a specific population. It is expected that after controlling for the confounding variables, the findings will reflect the impact of group medical visits on HbA1c levels in adults with type 2 diabetes.

Ethical Considerations

Participation in the study will be voluntary. The researcher will obtain written informed consent to take part in the study. Eligible subjects will receive the consent form together with the invitation to participate in the study. The privacy of the patients will also be upheld. Since the study will involve human subjects, permission to conduct the study will be obtained from the clinic’s ethics committee.

Timeline

The entire study from the recruitment of subjects, commencement of the intervention, and measurement of outcomes will take 8 months. It will be expected that by the end of this period, the impact of group intervention on HbA1c levels in diabetic African Americans will be ascertained.

Qualitative Study

Background of the Study

Adulthood is marked by contending social, occupational, and financial burdens, which pose unique challenges for patients with type 2 diabetes. The competing priorities often lower compliance with self-care measures hence leading to poor glycemic control and related complications such as microvascular problems, extreme hypoglycemia, and ketoacidosis. Type 2 diabetes is a chronic disorder that needs constant medical follow-up and continuous self-care. Healthcare systems around the world face the challenge of increasing numbers of chronically ill patients and a reducing physician labor force, particularly in primary care [9]. As a result, policymakers are exploring new paradigms of providing primary care to enhance quality and productivity. Group medical visits are a useful strategy that can help to address the shortage of primary care physicians while ensuring that a large number of chronically-ill patients receive care. However, there is little information regarding diabetic patients’ views of group medical visits. Therefore, there is a need to conduct a qualitative study to investigate patients’ attitudes and feelings towards this therapeutic approach.

Significance

Approximately 27 million people in the United States have type 2 diabetes, whereas 86 million have prediabetes [1]. There is adequate evidence to prove that strengthening the foundation of primary health care is likely to enhance health outcomes and improve the management of chronic diseases such as type 2 diabetes [3]. Group medical visits provide an idyllic arrangement for patients with chronic diseases such as diabetes because they allow patients with similar health conditions to interact in one appointment. Group medical visits have been reported to lead to significant improvements in glycemic control as measured by HbA1c levels [6]. This improvement is attributed to social support from peers during the group sessions. Therefore, it is hypothesized that the wider application of group medical visits will have a positive effect on patient outcomes for patients with type 2 diabetes. However, to increase the effectiveness of the intervention, it is necessary to identify patients’ views on group medical visits.

Qualitative research provides an exceptional opportunity for patient experiences to guide the development of effective intermediations to improve self-care in type 2 diabetes. Social aspects of healthcare may require a thoughtful exploration, especially when dealing with complex concepts that cannot be measured easily. Therefore, qualitative studies are desired when health science researchers wish to share personal experiences, comprehend the context of health issues, clarify connections in causal theories, and when conventional quantitative statistical evaluation approaches do not match the research problem. Descriptive research can also inform future investigations by identifying testable variables.

Purpose of the Study

The purpose of the study is to analyze the experiences of African American patients with type 2 diabetes mellitus on group medical visits.

The rationale for Selecting the Study Design

A descriptive qualitative study was chosen for this investigation. Qualitative descriptive studies are meant to portray the contributors’ views accurately and are open to research in the health arena because they yield realistic responses to questions concerning people’s feelings about specific phenomena [10]. A qualitative descriptive study about the views of African Americans on group medical visits will provide an in-depth understanding of patients’ perceptions of group medical visits. This information will inform medical providers about ways of enhancing the provision of group medical care. As a result, the outcomes of patients with type 2 diabetes will be improved.

Research Question

The research question for the study is “What is it like for African American patients with type 2 diabetes mellitus to experience group medical visits?”

Study Design

A focus group approach was chosen to gather detail and perspective about adult African Americans’ experiences of group medical visits in the management of type 2 diabetes. A series of three group sessions will be conducted to appreciate the patients’ understanding and experiences of group medical visits for diabetes care. Qualitative focus groups make it possible to look into numerous experiences, viewpoints, and sentiments within a group scenery [10].

Setting

The setting of the study will be an internal medicine clinic that provides a wide range of health services such as annual physical examinations, screening for hypertension, diabetes, and other chronic diseases. The populations served at the clinic include Whites, African Americans, Latinos, and a small group of Asians.

Sampling

A purposive sampling strategy will be used to identify the participants. African American patients with type II diabetes mellitus who are aged between 40 and 60 years will be selected. Only patients who have undergone group medical visits in the past year will be included in the study. Patients with type 1 diabetes and other comorbidities will be excluded from the study.

Procedures

Recruitment plan

The study team will contact eligible subjects and invite them to take part in the study. Introductory letters will be sent to all suitable candidates and followed by individual phone calls to confirm receipt of the invitation as well as participation in the study. Groups will be formed based on the participants’ level of glycemic control, which will be determined by the patients’ HbA1c levels as measured in the most recent visit before enrollment. Participants with HbA1c levels equal to or lower than 8.5% will be placed in one group. On the other hand, patients whose HbA1c levels exceed 8.5 will be placed in a separate group. The purpose of this approach will be to attain group homogeneity to enhance compatibility, unity, an exposé in the focus groups. Additionally, having similar levels of glycemic control will ease discomfort and eliminate feelings of competition during discussions.

Data collection method

A structured focus group guide will be formulated based on a thorough literature review of medical literature about the needs of adult diabetic patients. Medical providers specialized in diabetes care will be part of the team that will develop the focus group guide. The guide will include broad, open-ended questions to provoke specifics of the group medical visit experiences from a patient’s point of view. However, there will be room for revisions of the guide after the first focus group to accommodate emerging topics. Notable focus group guide items will include experiences in group medical sessions, the impact of group sessions on self-care, barriers to group sessions, and the impact of group sessions on the perception of diabetes. The following questions will be considered in the focus group guide.

• What is your experience in the group medical visits for diabetes care?
• Can you describe some of the challenges that you have encountered during group medical visits?

Each focus group will be facilitated by the same researcher, who will see to it that the group discusses all topics included in the guide. The group facilitator will also ensure that all group participants have an opportunity to air their views. A second researcher will take field notes to capture important observations about group discussions and associations. Each focus group discussion will last 60 minutes, after which the two moderators will meet to compare notes. Also, each session will be audiotaped and transliterated word for word by three team members in 30 days after each session. A quality check will be performed to authenticate the transcripts by paying attention to the recordings.

Data Analysis Plan

A thematic analysis will be used to analyze the data collected. The study team will meet at regular intervals to examine and evaluate the data based on the tenets of thematic analysis. The first phase of data analysis will involve each team member reading all the transcripts and notes, marking, and grouping the keywords to create initial codes [10]. These codes will be discussed by the entire group to work out any inconsistencies and create the primary thematic outline. This thematic framework will then be applied to all transcripts. Qualitative data analysis software such as NVivo 8 software will then be used for further grouping and organization of the codes to determine definitive themes.

Rigor

The credibility of the findings will be ensured by the triangulation of data sources. Researcher bias will be minimized by engaging a team of experts in the development of the focus group guide, conducting focus group sessions, and data analysis.

Study Team

The study team will include the principal researcher (self), two physicians with experience in adult diabetic care, and two physician assistants. The roles of each team member are explained in the data collection method.

Limitations of the Study

One possible limitation of the study is that subjects may not be honest about their opinions. There is a likelihood of unnatural behavior when subjects know that their actions are being monitored and recorded [11]. It is also impossible to determine a cause-effect relationship through descriptive studies. As much as the patient’s identities will be kept private, confidentiality issues may arise during the focus group sessions. As a result, some subjects may not be free to express their sentiments for fear of victimization. Researcher bias may also affect the findings of the study in several ways. For instance, the points in the focus group guide may lean towards the researcher’s interests [11]. The investigator is likely to make a skewed choice about the information to capture and accentuate the outcomes. Statistical evaluation of the findings is impossible. Therefore, the findings of such a study cannot be replicated and can be interpreted differently by different people.

Ethical Considerations

Participation in the study will be voluntary. The researcher will seek the subjects’ informed consent to take participate in the study. The privacy of the patients will be upheld because their names will not be mentioned anywhere in the study. Since the study will involve human subjects, permission to conduct the research will be obtained from the clinic’s ethics committee. Participants will also receive monetary compensation for their time.

Timeline

The entire investigation from the recruitment of subjects, data collection, and data analysis will take 3 months. It will be expected that by the end of this period, the researcher will have adequate information regarding the experiences of African American patients on the use of group medical visits for the management of diabetes.

Reference List

Franz MJ, Zhang Z, Venn BJ. Lifestyle interventions to stem the tide of type 2 diabetes. In: Temple NJ, Wilson T, Bray GA, editors. Nutrition guide for physicians and related healthcare professionals. New York: Humana Press; 2017. p. 103-112.

Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2): 137-149.

Block G, Azar KM, Romanelli RJ, Block TJ, Hopkins D, Carpenter HA et al. Diabetes prevention and weight loss with a fully automated behavioral intervention by email, web, and mobile phone: a randomized controlled trial among persons with prediabetes. J Med Internet Res. 2015;17(10): 240.

Nordwall M, Abrahamsson M, Dhir M, Fredrikson M, Ludvigsson J, Arnqvist HJ. Impact of HbA1c, followed from onset of type 1 diabetes, on the development of severe retinopathy and nephropathy: the VISS Study (Vascular Diabetic Complications in Southeast Sweden). Diabetes Care. 2015;38(2): 308-315.

Seiders K, Flynn AG, Berry LL, Haws KL. Motivating customers to adhere to expert advice in professional services: a medical service context. J Serv Res. 2015;18(1): 39-58.

Edelman D, Gierisch JM, McDuffie JR, Oddone E, Williams JW. Shared medical appointments for patients with diabetes mellitus: a systematic review. J Gen Intern Med. 2015;30(1): 99-106.

Kraemer HC, Blasey C. How many subjects? Statistical power analysis in research. 2^nd ed. California: Sage Publications; 2015.

Kuniss N, Müller UA, Kloos C, Müller R, Starrach G, Jörgens V et al. Substantial improvement in HbA1c following a treatment and teaching programme for people with type 2 diabetes on conventional insulin therapy in an in- and outpatient setting. Acta Diabetol. 2018;55(2): 131-137.

Crisp N, Chen L. Global supply of health professionals. N Eng J Med. 2014;370(10): 950-957.

Vaismoradi M, Jones J, Turunen H, Snelgrove S. Theme development in qualitative content analysis and thematic analysis. J Nurs Ed Pract. 2016;6(5): 100.

Willis DG, Sullivan-Bolyai S, Knafl K, Cohen MZ. Distinguishing features and similarities between descriptive phenomenological and qualitative description research. West J Nurs Res. 2016;38(9): 1185-204.

Introduction

Human health is one of the frequently discussed topics nowadays. It is not enough for people to know about health complications or impairments at different ages, and what can be done to avoid such problems. It is expected to understand what may cause diseases and disorders, what populations are at higher risk and why, and when it is time to take preventive measures or promote some changes. In addition to possible health complications, millions of people are concerned about the diseases that may cause death and the necessity to elaborate effective healthcare systems in each country. Cause-to-death statistics introduced by the World Health Organization (2017) show that approximately 56 million deaths happen due to such diseases as ischemic heart disease, stroke, COPD, respiratory infections, dementia, diabetes, and tuberculosis globally. Diabetes is also defined as one of the leading causes of death among the citizens of the United States (Centers for Disease Control and Prevention, 2017). Each population has a list of health problems to be exposed to at high risk. In this paper, the perceptions of diabetes in the United States will be investigated. Despite the possibility to create certain measurements of this nursing research project, it is also required to narrow down the topic and focus on diabetes from one particular group of people, the Hispanic population.

Diabetes is characterized by a high level of glucose (sugar) in the blood (American Diabetes Association, 2014). However, a definition, classification, and diagnosis of diabetes are more complicated than they seem to be and have to be thoroughly studied. Ramachandran, Snehalatha, and Nanditha (2017) define diabetes as a group of metabolic diseases that result in defects that are usually observed in insulin secretion and action. The peculiar feature of diabetes is its hidden dangers. This disease is progressive by its nature and may lead to numerous dysfunctions, long-term damage to the body, and failure of different organs in a short period. People of Hispanic origin are at the risk of having diabetes due to the existing cardiometabolic abnormalities, chosen lifestyles, and certain physiological characteristics (American Diabetes Association, 2014). Diabetes may be of type 1 and type 2. There is also a type known as gestational diabetes that is discovered during pregnancy and influences the development of a fetus, as well as a general condition of a woman. Common symptoms of all diabetes types in addition to a high level of blood sugar are frequent urination, weight changes, frequent and unexplained fatigue, thirst, and vision impairment. The reasons for such changes are the inability of the immune system to work properly and the destruction of cells that are responsible for insulin production in the pancreas.

At this moment, the investigations of the Centers for Disease Control and Prevention (CDC) (2017) show that more than 30 million people are diagnosed with diabetes (it is 9.4% of the US population) (Centers for Disease Control and Prevention, 2017). There is also a suggestion that about 7 million people who continue living with diabetes without even being aware of the possibility of this diagnosis, and approximately 84 million people are officially defined as pre-diabetic (American Diabetes Association, 2014). Health disparities in diabetes have been globally investigated during the last several centuries. Risk factors include age (older patients may suffer from heart diseases and strokes that promote complications), race/ethnicity (traditions may promote specific interests and lifestyles that lead to obesity or hypertension that turn out to be significant contributors to diabetes), and family history. In this project, special attention will be paid to Hispanic Americans with Puerto Rican, Cuban, Mexican, and South American descents. This group of people takes the third place (approximately 12%) in the list of adults diagnosed with diabetes, giving way to American Indians (15%) and African Americans (12.5%) (Spanakis & Golden, 2013). Diabetic patients may face certain challenges in diagnosing and treating despite their race or age, and perceptions of diabetes may vary but stay important for the US population and Hispanics in particular.

Problem Statement

Justification

Despite the existing diagnostic tools, preventive programs, and treatment plans, diabetes continues killing people around the whole globe. In addition to the fact that millions of people have to live with diabetes, restricting themselves in certain physical activities, interests, and personal demands, the governments of all countries have to spend millions or even billions (in case of the United States) of dollars to investigate all aspects of this disease. The US population is divided into several subgroups with their traditions, opportunities, and demands. Each group has its background, and representatives may be exposed to a specific disease due to family history, genomic structures, and the chosen styles of life.

The reasons why perceptions of diabetes in the Hispanic population vary. In this project, a researcher will be guided by several facts to justify this choice. These factors include:

1. The definition of Hispanics as a high-risk for diabetes group of people cannot be ignored;
2. Statistics play an important role: Hispanics are about 50% likely to die because of diabetes compared to Whites, many Hispanics are pre-diabetic, and more than a half of all Hispanic Americans do not know about having diabetes due to a weak healthcare system or poor communication with nurses or doctors;
3. The level of awareness about diabetes among the Hispanic population remains to be unstable or even unknown in some parts of the United States;
4. Diabetes is a serious global health problem that has to be solved regardless of people’s race, age, or gender, and the Hispanic population should have access to different knowledge, sources, and programs.

Problem Statement

Diabetes is on the list of dangerous diseases that may influence the quality of human life and the necessity to take treatment and promote changes from different perspectives. Its history began during the ancient times when the disease bothered people through extreme thirst and urine changes. Though this disease did not have the name or was known under other names, such symptoms as sweet urine and vision problems could not be ignored (Ramachandran et al., 2017). Different diagnostic methods and treatments have been developed through ages. Today, people know a lot about diabetes, its types, and treatment. Still, they continue dying because of diabetes, spending much money to treat it, or thinking about new interventions.

The main problem of this research is the necessity to prove that Hispanic people are under the threat of having diabetes with small chances to get rid of it with time. Hispanic Americans are poorly aware of this health problem and ask for additional help, care, and support. Despite the governmental involvement in diabetes programs, training and learning are not enough for the Hispanic population to predict and avoid diabetes complications. Therefore, it is expected to enlarge the level of knowledge about diabetes and its threats among the Hispanic population through increased discussions about diabetes’ signs, symptoms, diagnostic tools, interventions, and complications.

Objectives

The main goal of this nursing research project is to discuss the perception of diabetes in the Hispanic population. This purpose is general and requires the creation of several supplementary goals that cannot be neglected. For example, it is expected to investigate the health needs of Hispanic patients and management issues. The identification of every goal is a step in a plan of research that has to be developed. To achieve the main goal, the following objectives should be taken into consideration:

1. To define diabetes and its symptoms among the Hispanic population;
2. To review recent interventions and programs that have been offered to the population in the United States;
3. To investigate the existing self-management problems among diabetic patients and their doctors/nurses;
4. To focus on cultural, behavioral, emotional, and financial factors in diabetic treatment.

Definition of Key Terms

In this nursing research project, several key terms will frequently be used. Therefore, their definitions have to be given:

• Antibodies – blood proteins in the immune system that are created as a response to antigens (i.e., bacterium or virus).
• Beta cells – the cells that are located in the pancreas and responsible for the production of insulin.
• Blood glucose level – the identification of glucose in the blood at a certain period (if it is high, it means that the blood does not have enough insulin, and if it is low, it means that the level of insulin in the blood is extremely high).
• Diabetes mellitus – a full name of diabetes, a metabolic disease that is characterized by a high blood sugar level that depends on insulin production.
• Glucose – a sugar substance that is used to produce energy in the body.
• Hispanics – people of Puerto Rican, Cuban, Mexican, or South American descent who live in the United States.
• Insulin – a hormone with the help of which glucose is produced in the body.
• Pre-diabetes – also known as glucose intolerance, a condition with a high level of glucose in the blood but not high enough to be diagnosed as diabetes.
• Type I – also known as juvenile or insulin-dependent diabetes, a chronic condition when the pancreas is not able to produce enough insulin for body energy.
• Type II – also known as a non-insulin-dependent life-long disease or adult-onset diabetes that is usually observed in adults when the body can’t metabolize sugar.

Literature Review

Diabetes is a health problem that changes many lives of the Hispanic population in a short period whether it is a person who directly has diabetes or a family member who has to observe these changes (Ramachandran et al., 2017). Spanakis and Golden (2013) underline that health disparities in diabetes cannot be ignored because of multiple contributing biological and clinical factors. Diabetes is known as one of the possible causes of different health complications, including kidney failure, blindness, stroke, and cardiovascular diseases. The reasons that may cause this disease remain to be poorly investigated in the Hispanic population, resulting in the inability to develop effective interventions and treatment plans for patients. The reduction of morbidity is the goal that can be achieved. Still, socioeconomic factors, the necessity of acculturation and acceptance of new traditions, and poor learning or employment prevent an appropriate perception of diabetes in the population, promoting knowledge gaps, language barriers, and ineffective treatment.

Diabetes and Hispanics in the United States

Hispanics, also known as Latinos, are the people with Cuban, Mexican, or Puerto Rican origins who compose 15% of the total US population (about 53 million) (Spanakis & Golden, 2013). There is a suggestion that this number may be increased by up to 45% in 2060 (Ferguson, Swan, & Smaldone, 2015). Therefore, it is required to focus on the health of this population and discover the ways to educate people, provide them with care and support, and gain control over the incidence of diabetes and other diseases that may threaten human life.

The Hispanic population plays an important role in American life, determining the necessity of specialized health care, economics, and learning/employment conditions. Health conditions of Hispanics serve as important markers of public health in the United States (Zhao, 2014). Though the number of Hispanics who live in the United States continues increasing, the representatives of the CDC admit that they do not have enough information about Hispanic health to control the prevalence of the disease (Schneiderman et al., 2014). Self-reported cases of diabetes may be used as a basis for surveys and interventions. Hispanics can learn about diabetes and receive information about its complications from healthcare providers, friends, newspapers, the Internet, and television (Zhao, 2014). However, all these sources can be defined as inconsistent due to increased rates of diabetes and poor health outcomes in the Hispanic population (Ferguson et al., 2015). Yoshida et al. (2016) state Hispanic Americans who have diabetes have poorer access to care and lack health insurance compared to non-Hispanic Whites of the same region. The result of such barriers and challenges can be observed in wrong nutrition, harmful behaviors, and poor diabetes management.

Diabetes prevalence also depends on the geographical and gender factors. Hispanic men (approximately 16%) are under a higher risk of having diabetes in comparison to Hispanic women (approximately 17%) (Spanakis & Golden, 2013). Hispanics with South American roots have the lowest prevalence rates (about 10%). Then, Cuban Hispanics follow in this list of prevalence, composing 13%. The rates of Hispanics with Mexican or Puerto Rican roots are about 18-19%, proving that diabetes may become an epidemic for some groups of people (Spanakis & Golden, 2013). Yoshida et al. (2016) explain the role of acculturation in the life of Hispanics and people’s intentions to follow the values, traditions, and behaviors of the host country. High consumption of sugar and fast food and low intake of fruits, vegetables, and ordinary water is inherent for many Americans. A considerable part of Hispanics tries to take similar steps and change their habits to become a worthwhile part of society. However, their bodies and immune systems are not as prepared for such changes and new diets as their brains can be (Yoshida et al., 2016). Cultural, socioeconomic, and language barriers challenge many Hispanics and promote health complications that result in diabetes (Spanakis & Golden, 2013). Therefore, it is required to understand what Hispanic people know about diabetes, and what improvements can be offered to them regarding diabetes management.

Diabetes definition

Every researcher or writer aims at developing a specific definition of diabetes and covering all its characteristics. As a rule, diabetes is included in a group of metabolic diseases where hyperglycemia is observed because of a low level of insulin. Insulin has to transport glucose to cells where it can be used for energy production (Ramachandran et al., 2017). Hispanic Americans have increased insulin resistance that determines glucose metabolism and reduced insulin sensitivity (Spanakis & Golden, 2013). Diabetes may be of two types. Type I diabetes occurs when no insulin that is necessary for keeping energy in the body is produced in the pancreas (Ramachandran et al., 2017). In most cases, this type of diabetes is observed among children or young patients who have to take insulin day by day to live.

Type 2 diabetes is another form of the disease that differs from the first type by a possible presence of insulin in the body that works in the wrong way. Being one of the most common types of diabetes, this disease may be developed at any age because of family history, obesity, and glycemic complications (Zhao, 2014). In many cases, researchers do not differentiate type 1 diabetes from type 2 diabetes to gather as much information as possible and focus on this disease prevention (Schneiderman et al., 2014; Yoshida et al., 2016). The peculiar difference between these types is their symptoms or, to be more exact, the period and urgency of the first symptoms’ recognition.

Diabetes symptoms

Though the symptoms of both types are similar, they may be recognized at different stages. As a rule, patients with type I diabetes can experience certain health changes, report on them in a short period, and perform self-care as a part of diabetes management (Ferguson et al., 2015). Still, millions of people continue living with type II diabetes without even knowing about it because of no evident symptoms being observed. Such unawareness may be explained by poor knowledge and education offered to the Hispanic population, on the one hand, or the inability to identify true causes of diabetes, on the other hand (Zhao, 2014). Frequent urination, excessive thirst, and fatigue without any reasons, blurred vision without any traumas, and weight changes are the common symptoms that may be developed slowly or fast, depending on the type and the condition of patients (Zhao, 2014). The excess of sugar promotes new changes in the body, and a patient feels uncomfortable while doing regular activities.

Diabetes diagnosis and treatment

The risk of having diabetes groups include people who are 45-year old (or older) and obese or have a similar family history. In such cases, it is recommended for them to take regular tests to identify if they have diabetes or not. Today, several tests can be used to test the level of glucose in the blood depending on the urgency of diagnosis and the necessity to take as close results as possible. The most frequent tests are A1C (glycated hemoglobin test) that may be used to indicate the level of glucose during the last three months and OGTT (oral glucose tolerance test) that shows the level of sugar in the blood annually (Schneiderman et al., 2014). Random and fasting plasma glucose tests (RPG and FPG) are offered at some hospitals in case fasting is possible to control. However, the investigations developed by Zhao (2014) and Ferguson et al. (2015) show that not all Hispanic Americans are aware of available tests and their possibility to be checked for this disease at free or specialized clinics.

Diabetes and its treatment have to be properly discussed in the Hispanic population because of the necessity to reduce the cases of death and complications caused by diabetes. Though it is a hard task for ordinary people to live with diabetes, several simple and effective steps that can be taken to facilitate this condition. Preventive medicine is available to all people and includes regular physical activities, no smoking, and healthy nutrition (Spanakis & Golden, 2013; Yoshida et al., 2016). People with diabetes have to monitor the level of blood sugar regularly and know where they can address for urgent help. Management of diabetes mellitus may be developed in several stages. Spanakis and Golden (2013) admit that physically active patients with no smoking habits report on diabetes complications rarely. Community education and support are effective for diabetic patients.

For example, Ferguson et al. (2015) introduce diabetes self-management education for the Hispanic population with special attention to cultural varieties, eating behaviors, and personal beliefs that may determine the quality and frequency of treatment. Finally, research by Yoshida et al. (2016) examines the effectiveness of nutrition among diabetic Hispanics. The work by Zhao (2014) can be used as a strong supportive tool in terms of which different sources of health information and diabetes knowledge in the Hispanic population are discussed to prove that people are free to learn a lot in case they are properly motivated.

The importance of motivation is a crucial factor in diabetes management. The rates of diabetes among Hispanic patients may be explained by poor motivation or the lack of attention to ethnic subgroups in hospitals. Motivation has already been proved as an important part of diabetes management in such countries as Saudi Arabia (Al-Mutairi, Bawazir, Ahmed, & Jradi, 2015). It is high time to discuss the possible impact of the motivation of the Hispanic population in their needs to prevent or treat diabetes or reduce the number of death because of this disease.

Conceptual Model

In this research, a conceptual model will be used as a plan with the help of which an understanding of diabetes mellitus in the Hispanic population can be promoted. It is not enough to have a plan for discussion of diabetes. It is required to understand what each task can bring to research and what contributions may be expected. As it is shown in Figure 1, this model may be a solid mechanism for identifying and explaining diabetes:

According to this model, the analysis of diabetes should be organized in several stages. First, diabetes has to be properly identified as discussed through its two types, I and II. Then, the main symptoms of diabetes have to be described to understand what problems and changes matter for diabetic patients. The next step in the analysis of perceptions of diabetes is the evaluation of diagnostic tools. As long as people recognize what type of diabetes they have, nurses and other medical staff should discuss the peculiarities of management and treatment. It is necessary to admit that treatment may be pharmacological and non-pharmacological. Both types have to be described with clear examples given. Finally, risk factors for diabetes may vary, and patients should be aware of these factors to take precautionary measures. Researchers identify such factors as age, gender, education, lifestyle, and traditions (Zeng, Sun, Gary, Li, & Liu, 2014). As a result, diabetes of both types has to be investigated from the Hispanic population perspective, including available diagnostic tools, management, and treatment. These steps are necessary for the researcher’s intentions to understand what kind of work and support has already been offered to the population. Also, new interventions and improvements may be identified regarding the existing diabetes basis in the United States.

Theoretical Model

To support the conceptual model for understanding diabetes in the Hispanic population, a theoretical framework is also offered. It is based on the health belief model (HBM). This psychological model was introduced by Hocbaum, Rosenstock, and Kegels in the 1950s (“Health belief model,” 2017). It aims at explaining the health behaviors of different populations regarding disease and health impairments observed. According to this model, people may improve their everyday activities in case they know that avoidance of negative health conditions is possible, positive outcomes may be expected from recommendations, and the success of a recommended health action can be achieved.

This model focuses on benefits that may be achieved by patients in their intentions to learn more about diabetes and make a correct decision as it is shown in Figure 2. It includes several important variables like barriers that exist in the health system, severity and susceptibility the assessment of which show risks and consequences of the problem, self-efficacy that demonstrates people’s perception of their competence to successful behavior, social support, and self-care behaviors that promote an understanding of diabetes in one particular population. These variables are effective to measure the psychological, emotional, and behavioral impact of diabetes on the population (Al-Mutairi et al., 2015). People have to be properly motivated to comprehend what they can or cannot do to avoid diabetes complications, what the government can offer to the healthcare system and its population, and why diabetes knowledge is important. At the end of the project, a researcher should use this model to clarify if awareness of diabetes and its preventive treatment and cautions are effective for the Hispanic population who live in the United States.

Research Methods

This research project will be a descriptive study the goal of which is to describe the information available on the chosen topic and create a general picture of diabetes as a health problem that bothers the Hispanic population. The main research instrument will be a systematic review of the literature that is associated with diabetes and its incidence among the Hispanic population. The systematic review is a process in terms of which several studies will be selected by specific inclusion criteria. This research method will help to identify the gaps in current research, understand the chosen topic, clarify new perspectives on diabetes treatment, and learn how to combine theory and practice in one empirical study.

Population

The choice of a population plays an important role in this research. The task is not only to clarify the symptoms and outcomes of diabetes. The goal is to investigate this disease from one particular perspective – the Hispanic population. At this moment, about 52 million Hispanic people live in the United States, and 16% of them have diabetes (Spanakis & Golden, 2013). The main threat is that the majority of Hispanics remain unaware if they have diabetes or not. General statistical data about the Hispanic population of the US will be taken into consideration in the project. No particular cases will be discussed. This review will be based on the necessity to gather what the level of general knowledge of diabetes among the Hispanic population is, and if the population is aware of the basic preventive steps to avoid diabetes complications.

Sample/Materials

A search of such databases as Cochrane, PubMed, and the local library will be developed. It is expected to find at least 20 studies about diabetes in the Hispanic population and make sure that five of them meets the inclusion criteria, which are the year of publication (within the last five years, from 2013 till now), the geographical location (the United States), the population (Hispanics), and the disease (diabetes at any of its stages). Also, the review will be improved with the help of available statistical data and scholarly material that describes diabetes from different perspectives.

All studies have to be published in peer-reviewed journals. The research methods chosen by other authors should not play a role in the study. Still, it is better to identify the approaches chosen to understand how the information was gathered, and if the material could be defined as credible. The methodology of a future nursing research project is based on a descriptive study with the literature review as the main research instrument in terms of which it can be possible to identify the approaches of other authors and use them as a solid background for understanding the perceptions of diabetes in the US Hispanic population.

Findings

The analysis of data that is relevant to the US Hispanic population with diabetes provides significant insights into the gaps in diabetes knowledge, management, and treatment. The investigation should show if Hispanic Americans, as well as other representatives of the US population, have extensive access to health information about diabetes and other diseases and their treatment options or not. However, even without any clear conclusions and real steps, it is wrong to neglect the presence of certain problems and inconveniences for diabetic patients in their intentions to improve their knowledge and gain control over rates and diabetes incidence. In this chapter, the evaluation of expected findings will be given to clarify if this research project has a rationale and what results and outcomes may be observed.

Findings of the Study

A systematic review of the literature is chosen as the main research method for this nursing project. The goal is to identify what knowledge and practices are available to diabetic patients in case there are members of the Hispanic community in the United States. Many Americans have their health insurance and medical plans with the help of which they can be diagnosed at any time and received required care and support. Hispanic Americans are usually challenged in their opportunities. Some of them do not have health insurance, and some of them lack knowledge about how dangerous diabetes can be. At the end of the work on this project, it is expected to explore additional options for diabetic patients in the following directions:

1. General facts about diabetes, statistics, and personal experiences of different ethnic/race groups have to be shared in different ways (TV, online forums, special meetings, and learning courses).
2. Intentions of patients to learn more about their diseases and options (past studies prove that many Hispanic Americans understand the threats of diabetes and want to improve their health, avoid complications, and prevent extension).
3. Studies of several authors are directed to cover different aspects of diabetes treatment and clarify the outcomes that may and may not effective for Hispanic patients (the results of the literature review will be introduced in a separate table below):

In addition to the necessity to introduce the findings of the study in a table format, it is expected to use the already discussed health belief model and explain what benefits, barriers, and other factors may influence the perception of diabetes. The Hispanic population may or may not be motivated in a proper way to solve their health problems. The role of the government should be identified so that the socio-economic challenges of the Hispanic population may be solved. Finally, the findings of the study should touch upon the interventions that can help the Hispanic population to improve their diabetic knowledge, predict diabetic complications, and investigate all sources to exchange information about the disease.

Discussion

The implications of the findings that can be achieved at the end of this nursing research project may vary, depending on the objectives and main research questions. First, it is necessary to give a clear definition of diabetes and discuss all its types, signs, and symptoms to make sure that Hispanic Americans have access to credible and helpful information. The perception of diabetes depends on how many facts can be used to support a discussion and how much information a person can evaluate at once. Therefore, the more Hispanic patients know about diabetes before the diagnosis, the better. At the moment of receiving a diagnosis, a person can evaluate a situation and avoid confusion or misunderstanding of what has happened or why such a diagnosis is given.

The second aspect of the discussion will include the existing interventions, programs, and helpful centers where Hispanics can ask for additional explanations and support. In the chosen studies, the authors gave several strong ideas on how the Hispanic population can treat diabetes and what programs can be used. Self-management and education play an important role in the perception of diabetes. All people despite their race, age, and gender have to be willing to learn the basics of diabetes and the steps they can easily be taken to avoid diabetic complications.

Finally, the analysis of different factors that may differentiate patients with the same diagnosis is required. Within the frames of diabetic research in the Hispanic population, the attention to such factors as cultural, behavioral, socioeconomic, and financial ones should be paid. Some Hispanics may earn money and buy health insurance, but many of them are challenged by the conditions under which millions of immigrants live in the United States. The studies should help to clarify what challenges promote the development of pre-diabetic and diabetic conditions in case they are not genetic and biological ones.

Conclusions

In general, diabetes is one of the frequently discussed topics around the whole world. People want to know as much as possible about this disease to understand what they can do when they or their family members receive this diagnosis. This nursing research project has several clear and effective goals with the help of which it is possible to understand the relationship between diabetes and the Hispanic population. Many people think that they know a lot about diabetes in case they can give a definition, define symptoms, and enumerate diagnostic tools. However, this knowledge is far from being a full package of the material that has to be discovered about diabetes. This disease has pharmacological and non-pharmacological treatment approaches. Diabetic patients should change their lives and concentrate on the activities they found insignificant several years ago. Control of sugar level in the blood is a regular activity that cannot be neglected. This type of control may be maintained by specialized medical workers in hospitals or by patients using special tools at home. The only requirement that this test, as well as insulin intake, has to be taken all the time when a threat or change is observed.

A systematic literature review is a choice made by the researcher for this nursing project. This process of data gathering is effective due to the possibility to identify what achievements have already been made in the field, what statistical data is known, and why this topic is worth attention. Diabetes is a serious and dangerous disease that has already killed thousands of people and continues changing the quality of human life. The Hispanic population is defined as a high-risk for diabetes groups because of human genetics and acculturation. The lack of knowledge or poor treatment should not be a problem for these people, and this project will introduce a solid basis for helpful and necessary interventions to improve the perception of diabetes in the Hispanic population.

Recommendations

Taking into consideration the expected findings and the discussion that may be developed on the results, several recommendations may be given to improve research. First, the inability or unwillingness to distinguish between type I and type II diabetes in past studies deprives the researcher of an opportunity to identify the peculiarities of the disease, its causes, and symptoms. Therefore, one of the recommendations should aim at specifying diabetes from biological, genetic, and behavioral items.

Second, it is recommended to choose another research method and focus on new aspects of the discussion. For example, direct communication with the population or real-life interventions based on people’s needs and expectations can be offered. Interviews with 20-30 Hispanics of different origin may contribute to this research through credible qualitative information about what services can be offered to the population, what challenges may be observed in information exchange, and why diabetic knowledge is important for the US population. Questionnaires or online surveys help to gather quantitative information and use numbers to prove the importance of the chosen topic. Action research is another recommendation with the help of which perception of diabetes in the Hispanic population may be improved.

Finally, this research should have certain time frames. Diabetes is a disease with a long history, and multiple changes were observed at different epochs. Therefore, credible and up-to-date results can be achieved when diabetic Hispanics treatment is discussed within the last several years. However, every new step may have its limitations, and additional recommendations can be identified to improve the already done work.

References

Al-Mutairi, R.L., Bawazir, A.A., Ahmed, A.E., & Jradi, H. (2015). Health benefits related to diabetes mellitus prevention among adolescents in Saudi Arabia. Sultan Qaboos University Medical Journal, 15(3), 398-404.

American Diabetes Association. (2014). Diabetes among Hispanics: All are not equal. Web.

Centers for Disease Control and Prevention. (2017). National diabetes statistics report. Web.

Ferguson, S., Swan, M., & Smaldone, A. (2015). Does diabetes self-management education in conjunction with primary care improve glycemic control in Hispanic patients? A systematic review and meta-analysis. The Diabetes Educator, 41(4), 472-484.

Health belief model. (2017). Web.

Ramachandran, A., Snehalatha, C., & Nanditha, A. (2017). Classification and diagnosis of diabetes. In R.G. Holt, C. Cockran, A. Flyvbjerg, & B.J. Goldstein (Eds.), Textbook of diabetes (pp. 23-28). Hoboken, NJ: John Wiley & Sons.

Schneiderman, N., Llabre, M., Cowie, C. C., Barnhart, J., Carnethon, M., Gallo, L. C.,… Teng, Y. (2014). Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: The Hispanic community health study/study of Latinos (HCHS/SOL). Diabetes Care, 37(8), 2233-2239.

Spanakis, E. K., & Golden, S. H. (2013). Race/ethnic difference in diabetes and diabetic complications. Current Diabetes Reports, 13(6), 814-823.

World Health Organization. (2017).The top 10 causes of death. Web.

Yoshida, Y. X., Simonsen, N., Chen, L., Zhang, L., Scribner, R., & Tseng, T. S. (2016). Sociodemographic factors, acculturation, and nutrition management among Hispanic American adults with self-reported diabetes. Journal of Health Care for the Poor and Underserved, 27(3), 1592-1607.

Zeng, B., Sun, W., Gary, R.A., Li, C., & Liu, T. (2014). Towards a conceptual model of diabetes self-management among Chinese immigrants in the United States. International Journal of Environmental Research and Public Health, 11(7), 6727-6742.

Zhao, X. (2014). Relationships between sources of health information and diabetes knowledge in the U.S. Hispanic population. Health Communication, 29(6), 574-585.

The practice of manual information recording has been a norm for many healthcare facilities for years. However, with the increasing concerns about quality measurements, electronic health records (EHR) have started to become more popular as well (Clarke, 2013). In the presented scenario, a small practice has an EHR system, but all records are saved and input manually, thus making the computer system virtually useless in the setting. Therefore, the staff nurse has to take on the responsibility of collecting the necessary information by reviewing records. The initial step in this process would be to identify all patients with diabetes.

It should be noted that, according to the Healthcare Effectiveness Data and Information Set (HEDIS), only patients with type 1 and 2 diabetes are counted (National Committee for Quality Assurance [NCQA], n.d.). Patients with official diagnoses of gestational or other forms of diabetes are not included in such measurements. Thus, as the staff nurse, I would need to find all patients with the official diagnosis of type 1 or type 2 diabetes. This information is located in patients’ records along with other attached charts such as the results of blood tests.

The following step would be to identify whether the selected patients meet all components of the HEDIS comprehensive care measures. The first of these is hemoglobin A1c (HbA1c) tests (NCQA, n.d.). In this case, one can collect data from glycosylated or glycated hemoglobin testing that was performed in the years the results are requested. This information should be written down in the charts or attached to the latest screenings and tests. Next, the results of the tests will be turned into HbA1c control measure, and patients will be further separated into a number of categories. Thus, patients with HbA1c poor control (with the outcome of >9.0%) will be separated.

Other groups will also include HbA1c control <7.0, HbA1c control <8.0, and, finally, HbA1c control <9.0 (NCQA, n.d.). The data of these control groups rely on the latest tests. If some patients do not have available recent results, they may fall into the category of poor control (Kutz et al., 2018). Another measurement-based indicator is BP (blood pressure) control. Here, all patients whose BP is lower than 140/90 mm Hg fit the outline of HEDIS comprehensive diabetes care.

The next measure is the result of the medical eye exam performed recently or in the year of data collection. Here, one can utilize the findings of two types: the first is the dilated eye or retinal exam that was performed by a specialist in the year of data gathering (NCQA, n.d.). The second option is the result of the same exam that was performed in the year prior; however, the outcomes of this testing should not indicate the presence of retinopathy.

Patients with retinopathy whose tests were not updated do not meet the criteria for HEDIS comprehensive care (NCQA, n.d.). Finally, the last measure that should be collected is linked to neuropathy. In this case, as a staff nurse, I can search for urine or microalbumin tests in patients’ records as well as nephropathy screening tests (NCQA, n.d.; Verma, Kumar, Sharma, Singh, & Singh, 2017). By collecting these data in manual records, I will be able to calculate the number of patients that have diabetes and meet the components of the latest HEDIS comprehensive diabetes care.

References

Clarke, B. (2013). The cost of manual charting. Point of Care, 12(2), 67-68.

Kutz, T. L., Roszhart, J. M., Hale, M., Dolan, V., Suchomski, G., & Jaeger, C. (2018). Improving comprehensive care for patients with diabetes. BMJ Open Quality, 7(e000101), 1-6.

National Committee for Quality Assurance. (n.d.). Comprehensive diabetes care (CDC). Web.

Verma, M. K., Kumar, P., Sharma, P., Singh, V. K., & Singh, S. P. (2017). Study of microalbuminuria as early risk marker of nephropathy in type 2 diabetic subjects. International Journal of Research in Medical Sciences, 5(7), 3161-3166.

Introduction

Diabetes mellitus and diabetes insipidus represent different forms of alterations in a person’s processes of hormonal regulations. These disorders have many unique qualities that they do not share. The onset of diabetes insipidus is caused by the dysfunctional hypothalamic-pituitary system, while diabetes mellitus is connected to issues with the endocrine pancreas (Huether & McCance, 2017).

However, some of their symptoms, including increased thirst and polyuria can be highlighted as similar features of both conditions (Hammer & McPhee, 2014). Thus, the disorders may be difficult to distinguish without additional diagnostic measures. Such patient factors as ages and gender affect the development of both conditions. Diabetes insipidus and diabetes mellitus have different pathophysiological processes but possess some similarities in their clinical manifestations; the occurrence rates also differ by gender and age.

Pathophysiology

The pathophysiology of the discussed conditions differs depending on the cause. Diabetes mellitus has multiple types, each of which has a distinct set of processes. Type 1 diabetes mellitus is a chronic disorder that often manifests itself as an autoimmune response of the body to insulin. In the pancreas, the immune system activates T-cells that destroy beta cells, decreasing the production of insulin as a result (Huether & McCance, 2017).

In type 2 diabetes mellitus, some factors such as the abundance of insulin antagonists, altered glucose transporter proteins, or abnormal molecules of insulin lead to the increase in insulin resistance (Hammer & McPhee, 2014). Thus, while the body may produce insulin, the latter does not reach vital organs.

Diabetes insipidus can also develop in multiple ways, including central (neurogenic) and nephrogenic types. Central diabetes insipidus develops when the body does not produce a sufficient amount of anti-diuretic hormone (ADH) (Huether & McCance, 2017).

This can be caused by any type of brain lesion as wells as some genetic disorders. Neurogenic diabetes occurs in a hereditary pattern – the renal tubules of the affected person do not respond to ADH adequately, causing a disbalance in water regulation (Huether & McCance, 2017). As can be seen, the pathophysiology of the two disorders differs. However, water regulation problems can be seen in both conditions because, in diabetes mellitus, the high concentration of glucose causes reabsorption and dehydration.

Patient Factors

While genetics significantly influence the prevalence of the discussed disorders, other factors such as age and gender also play a crucial role in the conditions’ development. The frequency of occurrence of nephrogenic diabetes insipidus in men is much higher than that in women, while women develop diabetes mellitus (type 2) more often than men (American Diabetes Association, 2014; Bockenhauer & Bichet, 2015). Thus, the process of diagnosis should acknowledge this distinction in order to avoid an incorrect diagnosis. Women of childbearing age may be at risk for acquired conditions, especially if they are pregnant (American Diabetes Association, 2014).

Moreover, type 2 diabetes mellitus has a higher rate of occurrence in people older than 45 (Hammer & McPhee, 2014). On the other hand, diabetes insipidus occurs in people of all ages. In geriatric patients, it may be connected to lithium medications used to treat various mental health disorders (Bockenhauer & Bichet, 2015). Neonatal diabetes insipidus is also possible, it can lead to high rates of comorbidity (Djermane et al., 2016). Both groups should be treated with increased attention to the potentially exacerbating factors.

Conclusion

The differences between diabetes mellitus and diabetes insipidus are based on their pathophysiological processes. In the first disorder, the production and reception of insulin become the main issue. In the second type, the production of ADH affects the body’s water regulation system. Nonetheless, both conditions result in the person developing polydipsia and polyuria. The disorders affect people of all ages and genders, but risk groups exist for both conditions. Old age and female gender should be considered when diagnosing and treating diabetes mellitus, while male gender and old and young age are risk factors for some types of diabetes insipidus.

References

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Supplement 1), S81-S90.

Bockenhauer, D., & Bichet, D. G. (2015). Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nature Reviews Nephrology, 11(10), 576-588.

Djermane, A., Elmaleh, M., Simon, D., Poidvin, A., Carel, J. C., & Léger, J. (2016). Central diabetes insipidus in infancy with or without hypothalamic adipsic hypernatremia syndrome: Early identification and outcome. The Journal of Clinical Endocrinology & Metabolism, 101(2), 635-643.

Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of disease: An introduction to clinical medicine (7th ed.). New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Introduction

Diabetes technologies, historically divided into blood glucose level measurement and insulin delivery instrumentalities, are the terms to describe all kinds of devices and software that help patients with diabetes to control their glycemic level, prevent complications and acute events, and enhance the quality of life. The majority of healthcare organizations are continually developing measures oriented to diabetes treatment improvement. In 2017, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress organized an international panel of scientists and patients to summarize and advance the knowledge on continuous glucose monitoring (Danne et al., 2017). Recently, The American Diabetes Association (ADA, 2019) has updated its “Standards of Medical Care in Diabetes” with an additional section dedicated to modern diabetes technologies, treatment tools, and guidelines. The purpose of this research is the investigation of contemporary diabetes treatment facilities, their benefits, limitations, and integration into nursing practice.

Insulin Delivery

Insulin delivery is currently performed with a syringe or pen injecting, insulin pumps, or automated insulin delivery devices. Syringes or pens are commonly used by patients with type 1 and type 2 diabetes; these tools allow the delivery of insulin in a fast and effective way to improve blood glycemic levels. Choosing between a syringe or pen, a physician necessarily considers the self-management capabilities of a patient, his preferences, dose schedule, and insulin type. According to ADA (2019) “the most common syringe sizes are1 mL, 0.5 mL, and 0.3 mL, allowing doses of 100 units, 50 units, and 30 units of insulin, respectively” (p. S72). Insulin pens come as a disposable (with a single insulin dose) and reusable (with replaceable cartridges) device for push-button injections and an optional memory function of timing and doses.

Continuous subcutaneous insulin injections (insulin pumps) are being used for diabetes treatment in recent years; these tools provide patients with rapid-acting insulin doses throughout the day for glucose control. This measure requires the use of tubing and a cannula to deliver insulin, although, modern devices are attached directly to the skin. The pump therapy for adults and children is successfully used from the stage of diagnosis; though, it is performed after an in-depth examination of the patient’s individual characteristics, appropriate insulin delivery system, insulin type, and potential complication risks. Nevertheless, despite the risk of ketosis, device wearability discomfort, and possible mood disorders, continuous subcutaneous insulin injections are commonly chosen by individuals with high socioeconomic status, determined by the level of income, education, ethnicity, and health insurance.

Glucose Level Measurement

Glucose level measurement is considered critical for effective diabetes treatment and patients’ life level maintenance. Measurement of glycated hemoglobin has continuously been the traditional method of blood glucose control, although it does not reflect interday glycemic excursions and increases hypoglycemia and hyperglycemia risks (Danne et al., 2017). Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) were developed as modern diabetes treatment measures to improve blood control and the quality of living for insulin-dependent and insulin-independent patients.

Self-monitoring of blood glucose was included in diabetes therapy as an effective, complementary method of glucose level observation. The frequency of checking depends on the patient’s age and diabetes type. All patients, while monitoring their blood glucose, should receive essential instructions concerning the technique and results. SMBG is crucial for insulin-dependent patients to avoid morbidities: they are forced to assess glycemic level every day before food ingestion and postprandially, before bedtime, exercises, and important tasks, after low blood glucose treatment, and in case of glucose level decrease expectancy (ADA, 2019). The majority of patients require up to 6-10 checks per day, although the frequency can be varied individually. Despite that standard glucose monitors initially perform accurate results, inappropriate temperature, level of blood oxygen saturation, and test strips’ condition can influence accuracy.

Continuous glucose monitoring measures interstitial glucose; this method is safe and effective for patients with well-control insulin-dependent diabetes, which does not require daily SMBG. CGM devices are represented in two types – real-time continuous glucose monitoring (rtCGM), which contains alarms informing about glycemic excursions, and intermittently scanning CGM (isCGM), which is performed on-demand and approved only for adults (ADA, 2019). CGM results provide more opportunities for a thorough examination and analysis of patients’ data as CGM metrics contain an average glucose level, percentage of time in the target range, hypoglycemic range, and hyperglycemic range. Combined with automatic pump therapy, rtCGM substantially reduces the risks of hyperglycemia episodes and their severity. rtCGM, as close to daily monitoring as possible, can improve neonatal incomes for pregnant women with insulin-dependent diabetes.

Conclusion

In recent years, diabetes treatment measures are continually improving to minimize risks of complications, provide qualified medical assistance, and reduce patients’ burden of living with diabetes. The measurement of glycemic blood level to prevent excursions of glucose and insulin delivery facilities are two basic components of diabetes therapy. Moreover, diabetes treatment measures and tools are chosen for individuals according to not only age, diabetes type, the extent of disease, personal characteristics, and preferences but their socioeconomic status and cultural differences as well.

References

1. American Diabetes Association. (2019). 7. Diabetes technology: Standards of medical care in diabetes – 2019.Diabetes Care, 42(Suppl. 1), S71–S80. Web.
2. Danne, T., Nimri, R., Battelino, T., Bergenstal, R.M., Close, K.L., DeVries, H.,…Phillip, M. (2017). International consensus on use of continuous glucose monitoring. Diabetes Care, 40, 1631–1640. Web.

Related Issues

Over time and depending on the severity of a particular case of diabetes, a form of nerve damage called neuropathy can actually occur resulting in either chronic pain in the toes, arms, legs, feet, or arms of a person or a complete loss of sensation felt like either a form of weakness or numbness in the affected area (Ziegler, et al. 2009). Early identification and intervention are necessary in order to determine the extent of the pain, whether it has other underlying causes, and to administer some form of treatment whether in the form of prescribed medication or even surgery (Bair, et al. 2010).

Unfortunately, one of the problems to diagnosis is the fact that many individuals suffering from discomfort or pain (often the elderly) at times deny feeling any pain whatsoever in order to exude an image of health and wellness while in reality they are in severe pain and are barely able to function (Bair, et al. 2010). It is based on this that this paper will develop a questionnaire and utilize it on a variety of respondents currently afflicted by diabetes. It is the goal of this paper to develop an effective method of questioning so as to facilitate better practices of intervention so as to prevent a patient’s condition from worsening.

Questions

• Would you say that within the past two weeks you have been experiencing random moments of slight pain in different areas of your body?
• If you have experienced sudden pain as a result of your condition would you say that it has been escalating or abating?
• What area on your body would you say gives the greatest amount of discomfort on a weekly/daily basis?
• Do you experience pain as a result of doing particular activities?
• Would you say that after resting for a few hours the pain you experienced has abated or is it still present?

Strategy in Gaining Participants

It is the belief of this paper that the best strategy for gaining respondents is to go to various clinics and hospitals within the local area and ask people that have been diagnosed with diabetes if they would be willing to answer a short questionnaire in order to facilitate better medical practices in the future. Other potential strategies include the use of surveymonkey.com, a free online survey maker, wherein through the use of online social media such as Facebook and Google Plus various respondents can be contacted and asked to fill out the survey online. It is expected that by utilizing such methods a sufficient number of respondents will be reached resulting in a greater degree of accuracy regarding the survey results.

Planned Methodology When Questionnaires are being given

In the case of face-to-face interactions, when asking people to fill out the questionnaire what will be done is to first ask the person regarding their past experiences as a diabetic. This will include their personal history with the condition, their methods of coping with it, and how it has affected their lifestyle.

The reason for doing this is quite simple, by talking more about how the disease has affected the patient in the past the interviewer can gain an insight into the level of pain they suffered regarding the disease and can somewhat diagnose the accuracy of their questionnaire based on these statements. It must also be noted that by talking to patients in this particular manner the interviewer eases the patient in trusting the interviewer more thus resulting in the likelihood of more accurate surveys. In the case of online survey taking, a short video clip posted on YouTube will be provided to participants in order to get them to feel that they are having a face to face interview.

Experience in Administering the Questionnaire

Overall, I would have to say that the experience of administering the questionnaires was an insightful one wherein I was able to learn the extent of pain the people suffering from diabetes went through on an almost daily basis. From this experience, I was able to determine that each individual has a different way in which they want others to perceive the level of pain that they are going through, and as such, they express this at times in rather vague and at times inaccurate results due to their belief that they “must look strong”.

Participant Feedback

When filling out the questionnaire most participants did say that the questions were fair however they did indicate that question 5 implied that they were already experiencing pain while the previous 4 questions could be assumed as asking whether they had pain or not. Thus, question 5 needed to be revised based on their feedback

Revised Questions

• Would you say that within the past two weeks you have been experiencing random moments of slight pain in different areas of your body?
• If you have experienced sudden pain as a result of your condition would you say that it has been escalating or abating?
• What area on your body would you say gives the greatest amount of discomfort on a weekly/daily basis?
• Do you experience pain as a result of doing particular activities?
• In the instances that you do feel pain, would you say that after resting for a few hours the pain you experienced has abated, or was it still present?

Revised Plan

The plan is considered sound and as such there will be no revision done.

Reference List

Bair, M. J., Brizendine, E. J., Ackermann, R. T., Shen, C. C., Kroenke, K. K., & Marrero, D. G. (2010). Prevalence of pain and association with quality of life, depression , and glycaemic control in patients with diabetes. Diabetic Medicine, 27(5), 578-584.

Ziegler, D., Rathmann, W., Dickhaus, T., Meisinger, C., & Mielck, A. (2009). Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: The MONICA/KORA Augsburg surveys s2 and s3. Pain Medicine, 10(2), 393-400.